Provider Demographics
NPI:1295058543
Name:KIM, YOUNG KWAN (LAC)
Entity type:Individual
Prefix:MR
First Name:YOUNG KWAN
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7815 GREENWOOD AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-4633
Mailing Address - Country:US
Mailing Address - Phone:206-518-0841
Mailing Address - Fax:206-782-6432
Practice Address - Street 1:7815 GREENWOOD AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-4633
Practice Address - Country:US
Practice Address - Phone:206-518-0841
Practice Address - Fax:206-782-6432
Is Sole Proprietor?:No
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60126401171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist